BMI Inc 4/3/2019 - Laserfiche WebLink

• City of Everett Healthcare Management Administrators • Audit Agreement-2019 HMA or Regence Information concerning Group,which is the subject of the final audit report, shall not be re-audited at any time without the express written permission of both HMA and • Regence. • 4. .Alt di'ti''>i+efi "la1 Audit teuort. A final draft of issues contained in the audit report("Draft Report")shall be submitted to HMA . for review by HMA within thirty(30)days following completion of audit procedures and at least fifteen(15)business days prior to the Draft Report being delivered to Group's management. During this fifteen(15)day period,HMA and/or Regence may review the Draft Report for • disclosure of such proprietary,trade secret,or other confidential information which may be in violation of state or federal laws and/or the terms of this Agreement. If HMA determines that the Draft Report contains such information,it may,within such period,direct Auditor to delete the information,and if so directed,Auditor shall delete such information from the Draft Report prior to delivery of the Final Report. The exit conference will equate to completion of the audit procedures for purposes of the aforementioned timing. HMA may further review the Draft Report for inaccurate information or findings on Regence's claims administration or claims payments. HMA may notify Auditor of any disputed findings contained in the Draft Report and request that the report be corrected. If Auditor agrees the information is incorrect,the report will be corrected. Otherwise,a statement from HMA and/or Regence indicating disagreement with certain findings will be included in the Final Report. agrees rees to provide HMA with a copy of all HMA-related issues as presented"in1llieTina' Report within two(2)days of delivery of the Final Report. Auditor shall not disclose Personal Information to the plan sponsor of Group unless or until Group certifies that its plan documents have been amended in accordance with 45 CFR§ 164.504. If Auditor does not receive certification from the Group,the Final Report and all Personal Information shall be disclosed to the group administrator of Group. 5. Audit Conclusion The audit support activities undertaken by HMA and/or Regence will be deemed completed and closed upon Auditor's presentation of the Final Report to Group. Any sample claims identified as errors during the audit,will be reviewed and re-processed in accordance with HMA's standard practices. Any sample claims identified as overpayments still within the adjustment period at the time recovery needs are identified will have recovery efforts initiated automatically. Overpaid claims identified that are outside of the applicable Provider recovery window(24 months/Institutional-Facility claims; 12 months/Professional)will be deemed informational only and no recovery or reimbursement will be required.HMA will not be required to reimburse , Group for any claims processed in error. Impact analysis requests to audit other claims based on error types identified in the Audit during the audit timeframe will be considered on a case by case basis as a separate project outside of the Audit. Scope,timeline and costs for this additional analysis of Group claim data will be negotiated directly with Group. 3